Provider Demographics
NPI:1720706716
Name:VARELA, RAYMUND V
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:V
Last Name:VARELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 S PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9470
Mailing Address - Country:US
Mailing Address - Phone:480-524-4097
Mailing Address - Fax:
Practice Address - Street 1:74 S PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-9470
Practice Address - Country:US
Practice Address - Phone:480-524-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator